When terrible things happen in our communities, countries and the
world, we want to reach out a helping hand to those who are affected.
The Psychological First Aid: Guide for Field Workers (WHO, WTF, WVI,
Geneva: World Health Organization 2011) covers an approach which
involves humane, supportive and practical help to fellow human beings
suffering serious crisis events. it is written for people in a position
to help others who have experienced an extremely distressing event. It
gives a framework for supporting people in ways that respect their
dignity, culture and abilities. Despite its name, psychological first
aid covers both social and psychological support. The guide has been
translated and is freely available in several languages and applied in
various regions of the world - from Latin American and the Caribbean, to
Africa, the Middle East, Asia and the Pacific.
For those interested in techniques and resources for orienting others in
psychological first aid - be they medical personnel, other emergency
responders, humanitarian aid staff, teachers, or community members -
this pre-meeting institute offers techniques and resources for designing
a participatory, skills-based orientation relevant to the socio-cultural
context of participants, the crisis situation, available resources and
stakeholders. It draws upon experience of PFA faciitators who have
conducted orientations in many parts of the world, including national
scale capacity building efforts in Japan and the east Asia region. Other
resources include the PFA: Facilitator's Manual for Orienting Field
Workers (WHO, WTF, WVI 2013) and all materials necessary for conducting
an orientation. Participants will have the opportunity to learn how to
adapt activities for comfort, safety and optimal learning of diverse
participants and to design an orientation relevant to their context.

PMI
02

Four Leading Model Developers Address Complex Case Material and Real
World Implementation Issues.

This full day pre-meeting institute, endorsed by the Complex Trauma
SIG, will feature a unique opportunity to hear from developers of four
leading evidence-based models for complex trauma intervention developed
by members of the NCTSN over the past decade: Trauma Focused Cognitive
Behavioral Therapy (TF-CBT), ARC (Attachment, Self-Regulation and
Competency), TARGET (Trauma Affect Regulation: Guide for Education, and
Trauma Systems Therapy (TST).

The morning session will begin with each model developer presenting a
brief overview of their model. The moderator will then present complex
case material, and each model developer will discuss the case from the
perspective of their intervention. Each discussion will take into
account factors common to addressing child trauma, and will discuss the
rationale for their approach, and why certain factors are or are not
included in the model. Factors to be addressed include: child and family
engagement; establishing safety; addressing emotional and behavioral
regulation; integrating trauma history; facilitating future orientation;
organizational factors; the role of the child’s social
environment; partnering with community agencies, among others.

For the afternoon session, we will focus on how each model addresses
real world implementation issues. We will invite participants to present
brief case vignettes which highlight issues they have struggled with.
Each model developer will respond regarding how they would approach such
issues from the point of view of their model. These may include issues
such as psychiatric emergencies, concerns about child abuse,
hard-to-engage families, comorbid mental health and substance abuse
problems, parental mental health issues, etc.

We will then invite audience members to present questions or specific
issues to the model developers.

We will end with a moderated discussion of the relative applications of
the different models to varying situations and clinical
presentations.

PMI
03

The Application of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)
for Youth with Complex Trauma

Griffin, Jessica, PsyD1; Cohen, Judith,
MD2; Kliethermes, Matthew, PhD3;
Mannarino, Anthony, PhD41University
of Massachusetts Medical School, Worcester, Massachusetts, United
States2Allegheny General Hospital, Pittsburgh,
Pennsylvania, United States3University of Missouri St.
Louis, St. Louis, Missouri, United States4Allegheny
General Hospital/Drexel University College of Medicine, Pittsburgh,
Pennsylvania, United States

Children who have experienced complex trauma benefit from a
phase-based treatment approach (Cook et al, 2003). This workshop will
provide in-depth information related to the application of
Trauma-Focused Cognitive Behavioral Therapy for Youth with Complex
Trauma, with an emphasis on phase-based treatment. The objective for
this PMI is to provide practitioners with an increased knowledge base,
including theoretical understanding, clinical tools and techniques, as
well as research support related to the application of TF-CBT for youth
with complex trauma. This session will begin with a brief overview of
the TF-CBT model (Cohen, Mannarino, & Deblinger, 2006) as well as an
overview of complex trauma and the impact of complex trauma on children
and adolescents (Cook et al, 2003), including the impact of complex
trauma on multiple domains of functioning (e.g., Attachment, Physical
Health/Biology, Affect Regulation/Emotional Responses, Dissociation,
Behavior, Cognition, Self-Concept and Future Orientation). As TF-CBT
continues to be the most widely disseminated evidence-based treatment
for children who experience trauma, with 13 Randomized Controlled
Clinical Trials (including with youth with complex trauma), the
application of TF-CBT has evolved over the last decade in order to best
meet the needs of special populations (e.g., youth with complex trauma)
and to improve sustainability in diverse settings (e.g., residential
treatment, juvenile justice, in-home therapy), while still maintaining
fidelity to the treatment model. This training seeks to improve
sustainability of TF-CBT for agencies, clinicians, and stakeholders
providing TF-CBT in diverse settings or in settings that largely include
youth with complex trauma. This workshop will address prevalent
misconceptions regarding the TF-CBT model, particularly as it relates to
youth with complex trauma. Multiple considerations in the application of
TF-CBT for youth with complex trauma will be discussed including the
phase-based delivery of TF-CBT including three phases: 1) Safety and
Stabilization; 2) Trauma Processing; and 3) Integration and
Consolidation. This workshop will address how the components of TF-CBT
can effectively address the multiple domains of functioning impacted by
complex trauma. Data regarding TF-CBT with youth with complex trauma
will be presented. Throughout the institute presenters will encourage
interactive discussion about how to implement TF-CBT for youth with
complex trauma. Clinical vignettes, video, and demonstration of
techniques will be utilized in an interactive discussion between the
TF-CBT developers and national trainers.

This PMI will teach the core competencies for military cultural
competence for those who work with with Service members, Veterans, and
their families. It will be based on a recently released integrated
VA/DOD online full day course. The focus will be on how to improve
assessment and treatment planning for those patients with trauma-related
conditions who are or have been in the military. Participants will be
educated about the military culture and how that culture may affect the
self and world views of their clients and therefore the patient/provider
relationship. They will be invited to assess their own bias, beliefs and
assumptions about the military which may inadvertently contribute to the
stigma associated with seeking mental health care. Even VA and DoD
providers who believe they have a good understanding of military culture
from having been in the service themselves, or from having served as a
healthcare professional in the system for many years, may not have a
broad understanding of all branches of service, of different eras of
Veterans, and of the many subcultures and subtleties inherent in
military culture. The goal of this PMI is to educate providers
interacting with traumatized Service members, Veterans and their
families about aspects of the military culture such as military ethos
and core values, stressors associated with military life, and resources
and tools that are available to patients and their providers working
together to address these issues. This PMI aims to additionally increase
understanding of the various ways that the impact of military culture
can differ across patients. Military ethos will be defined, as well as
some of the more tangible or material elements and behaviors associated
with military service such as customs, structure, organization and
roles. Information will be given on common stressors experienced by
Service members and their families as a result of demands distinctive to
military life as well as resources that are available in an effort to
promote adaption and adjustment to challenges. Finally, treatment
resources and tools will be reviewed with a focus on how to apply
cultural knowledge in patient care. The PMI will include videotape
vignettes; assessment and treatment planning tools for health care
professionals; lists of resources; and interviews with dozens of Service
members, Veterans, family members and healthcare provide

Wednesday, November 5, 2014
Half-Day Institutes
(8:30 a.m. – Noon)

PMI
05

Changing the Pathway to Delinquency:
Mindfulness, Meaning-Making, and Relational Strategies Drawn from 3
Complex Trauma Treatments and Applied at 3 Time Points from Childhood
through Young Adulthood

Analyses of the National Child Traumatic Stress Network (NCTSN) Core
Data Set found that youth exposed to ongoing and/or multiple types of
traumas often display a broad range of “challenging” or
problematic behaviors, many of which place youth at-risk for juvenile
justice involvement. As an official submission of the Complex Trauma
Workgroup of the NCTSN, this pre-meeting institute will highlight how
techniques and approaches from 3 empirically-based treatment models can
prevent or reduce the development of emotional, behavioral, and
cognitive dysregulation associated with complex trauma Building on the
core components of NCTSN-recommended complex trauma treatment, each of
the three models, Real Life Heroes, ITCT (Integrative Treatment of
Complex Trauma), and SPARCS (Structured Psychotherapy for Adolescents
Responding to Chronic Stress), will present a range of approaches to
reduce behavioral and relational difficulties and risk-taking, develop
self-regulatory skills, support adaptive attachments, and facilitate
trauma-processing and meaning-making. Model developers will illustrate
activities and strategies, with an emphasis on the use of mindfulness,
and meaning-making in the treatment of a child with a history of
physical abuse, witnessing domestic violence, community violence, and
intergenerational transmission of trauma. Each model will be matched to
a specific developmental stage with the same child presented at 3
separate time points: RLH (childhood-6 yrs), ITCT (early adolescence-
14yrs), and SPARCS (young adulthood- 20yrs). Each developer will begin
with a brief overview of their respective model (including a review of
the emerging evidence-base), followed by a brief description of the
child’s evolving trauma history, present circumstances, and
current functioning. The majority of each presentation will describe
ways in which mindfulness and/or meaning-making can be used in treatment
at the given time point, and will illustrate the application of specific
techniques and strategies to engage children, caregivers and services to
work together to address client symptoms, and ameliorate factors leading
to high risk behaviors. Following the 3 model presentations,
participants will hear from the Chief of Mental Health Services from the
Illinois Department of Juvenile Justice and learn about the prevalence
of trauma among youth in juvenile justice centers, the shifting culture
of detention facilities, and policy implications and service gaps for
at-risk/delinquent youth. This intermediate-level PMI, will conclude
with a synthesis of the overlapping and unique features of model
components, practical application by practitioners, and next steps for
research with a moderated audience discussion led by an expert in the
field of complex trauma.

PMI
06

Treating the Sleep Disturbances of Adults with PTSD: CBT for Insomnia
and Imagery Rehearsal

This pre-meeting institute will provide attendees with an overview
over the treatment of the sleep disturbance associated with PTSD in
Veterans. Veterans often present for treatment with complaints of
disturbed sleep associated with their PTSD, and both insomnia and
nightmares are contained within diagnostic criteria for PTSD. There is
mounting evidence that cognitive behavioral therapy is efficacious in
treating the insomnia associated with many mental health problems
including PTSD. This seminar will focus on the application of CBT for
insomnia (CBT-I) to the treatment of Veterans with PTSD. In addition, we
will review a cognitive-behavioral treatment for posttraumatic
nightmares, which has received increased research attention, namely
Imagery Rehearsal therapy. A review of research evidence and an overview
of important techniques as applicable to Veterans with PTSD will be
provided. Specifically, the following topics will be included in this
pre-meeting institute:
1. Review of nature of the sleep disturbance in the context of PTSD:
What is insomnia in PTSD and phenomenology of nightmares.
2. Explanatory models of insomnia: 3 Ps model, circadian processes
3. Therapeutic strategies: Elements of CBT-I: Stimulus control, sleep
restriction, cognitive strategies (worry time), relaxation training
(PMR), sleep hygiene
4. Review of Imagery Rehearsal: research base, explanatory models
5. Elements of Imagery Rehearsal: Rationale, nightmare selection,
nightmare write-out, changing nightmare story, creating a new dream
script, rehearsal, fine-tuning
6. Integrating CBT-I and Imagery Rehearsal

PMI
07

Dimensions of Dissociation in Trauma-Related Disorders

Spanish Track: This will be presented in
English with simultaneous translation to Spanish

In this workshop we will review assessment and intervention
methodology relevant to addressing dissociative symptomatology in
individuals with PTSD. A dissociative subtype of PTSD has been defined
by the presence of self-reported experiences of depersonalization and/or
derealization. On the basis of neurophenomenological studies, Frewen and
Lanius (in press a,b) recently proposed a four-dimensional framework
(“4-D model”) that theoretically differentiates states of
posttraumatic distress that they argue intrinsically exemplify
dissociative trauma-related altered states of consciousness (TRASC) from
those that exemplify normal waking consciousness (NWC). In brief, the
4-D model classifies: 1) dissociative flashbacks as a TRASC of a
person’s sense of time-memory, considered distinct from other NWC
forms of intrusive recall of traumatic events that fail to provoke a
marked sense of reliving; 2) thoughts that occur in second-person
perspective, akin to voice-hearing (e.g., experiencing a voice inside
one’s head screaming “I hate you” as a TRASC of
thought demarcated from the NWC experience of having distressing
thoughts in first-person perspective (e.g., having the thought: “I
hate myself”); 3) experiences of depersonalization as a TRASC of
the body, theoretically differentiated from embodied experiences of
distress (i.e., as occur in NWC; e.g., psychophysiological arousal,
panic attacks without depersonalization/derealization experiences); and
4) marked cases of emotional numbing and affective shut-down as a TRASC
of emotion (akin to a feeling of “being numb” or
“emotionless”), considered unique as such relative to other
pervasive negative emotional states that commonly occur within NWC
(e.g., experiences of fear, anxiety, sadness, guilt, or shame, etc).
In this workshop, we will review research supporting the predictions of
the 4-D model in people with PTSD, BPD with or without PTSD, and within
the general population. We will review assessment scales for measuring
the dimensions of the 4-D model, and treatment approaches, focusing
particularly on mindfulness-based therapy. The workshop will be both
didactic and experiential in nature.

The primary objective of this intermediate Pre-Meeting Institute is
to provide attendees with specific techniques for successfully utilizing
Cognitive Processing Therapy (CPT) with adult patients presenting with a
history of childhood trauma (e.g., childhood physical/sexual abuse or
assault, domestic violence, school-related violence, and gang activity).
CPT is an evidence-based cognitive therapy for PTSD and trauma-related
disorders. Two variations of the treatment (with or without written
trauma narrative) have demonstrated robust effects in reducing the
frequency and intensity of PTSD symptoms in multiple randomized clinical
trials. The treatment may also be delivered in group, individual, or
combined formats, allowing for flexible implementation in a variety of
clinical settings.

This institute will involve an overview of social cognitive theory and
Socratic dialogue, followed by demonstrations of specific CPT
techniques, examination of case vignettes, and role play exercises to
provide opportunities for attendees to hone their skills. Throughout the
institute, presenters will address techniques for working with patients
with complex clinical presentations (e.g., multiple traumas,
dissociation, comorbid personality disorder, substance use, current
involvement in a violent relationship). Additional topics will include
working with beliefs related to punishment, blame/guilt, reactions to
authority, love of family, justice, religion, sexuality, and aggression.
Presenters will address special considerations for working with patients
of varied socioeconomic, cultural, and education backgrounds. Finally,
the presentation will also review methods for enhancing collaboration
between the patient and therapist and maintaining engagement in
treatment.

The target audience for this PMI is clinicians with a working knowledge
of CPT and an interest in augmenting existing cognitive therapy skills.
Although the presenters are CPT Trainers, this is not an introductory
training to the CPT protocol. Attendees who have not previously received
formal training in CPT may benefit from completing an online CPT course
(http://cpt.musc.edu) prior to attending the workshop.

PMI
9

Introduction to Genetic and Epigenetic Research in Traumatic Stress
Studies

The field of genetic and epigenetic research has made impressive
advances in the past few decades, catalyzing considerable excitement
about the ways that genomics can inform our understanding of critical
questions in the field such as why some trauma-exposed individuals are
resilient while others develop posttraumatic stress disorder (PTSD),
depression, and substance abuse. Given this growing literature, along
with commercially available high-throughput genomic platforms, it is
increasingly incumbent on researchers and clinicians to be familiar with
the basics of genomically-informative designs. Further, researchers are
increasingly interested in considering ways that genetic and epigenetic
methods can be incorporated into their work. The purpose of this
pre-meeting institute (PMI), targeted at researchers, clinicians, and
students with little familiarity with genetic methods, is to provide an
introduction to genetic and epigenetic methodology. State-of-the-science
findings in genomics of trauma research will be reviewed, and the
strengths and limitations as well as design considerations of these
approaches will be discussed.
This half-day PMI will address:
(1) Family and Twin Studies in Trauma: Basic methods and findings
related to understanding the contributions of genetic and environmental
influences on behavior will be described, including traditional
approaches such as twin and family modeling.
(2) Molecular Genetic Approaches: We will review candidate gene
research, genome wide association studies (GWAS), whole genome methods,
and gene-environment interplay. Important research considerations with
each of these methods will be discussed.
(3) Epigenetics: We will provide a brief overview of epigenetic
modifications, which involve chemical modifications that regulate
chromatin structure and/or DNA accessibility, which in turn alter the
transcriptional activity of the surrounding loci.
(4) Novel Approaches: Researchers have begun to explore new and
innovative approaches to the incorporation of genetic research into a
range of scientific queries, such as examinations of genetic and
epigenetic predictors of treatment response (both pharmacological and
behavioral treatments) or epigenetic modifications that are altered
through treatment involvement.

When a crisis or disaster occurs, the media will create and
disseminate stories of what happened, why it happened, and what should
be done in the future so it doesn’t happen again. Those working
with children, families, and communities have the ability to help media
tell stories that can promote (instead of impede) recovery and
resilience. This PMI session will help participants develop these skills
and will include the following components:

1. Discussion of how local and national media work, including an
examination of the roles, functions, and goals of the media, and a
discussion of what to expect from the media if a community crisis or
disaster were to occur.

2. Examination of strategies for working with the media at all phases of
a community crisis or disaster (before, during, and after). Strategies
covered will include: creating partnerships with local media before an
event occurs, establishing a public information office or plan during an
event, understanding “how” to talk with media, understanding
“what” to say to media, and a review of one’s own
media image.

3. Viewing and discussion of recent examples of media coverage of
community crises and disasters.

4. Role playing activity in which presenters and audience members
practice the process of being interviewed by a member of the media
following a community crisis or disaster.

5. Exploration of novel and emerging approaches to communicating with
the public about trauma, disasters, and community crises. This will
include the use of social media (e.g., Twitter, blogs) and digital
storytelling.

PMI
11

Focusing the Military Cultural Lens: Evidence-Based Practices Addressing
Child Trauma in Military and Veteran Families

Providing direct treatment services for military and veteran families
is a major goal for the National Child Traumatic Stress Network (NCTSN).
Many NCTSN programs have now implemented treatment services for military
families through outreach and partnership with active duty bases,
National Guard, and local VA hospitals. In order to prepare their staff
to serve military families, many programs have engaged in programs to
increase their knowledge of military cultural characteristics to
understand the types of stressors faced by military families and the
potential impact on the children. Further, these programs are now
extending their knowledge to include veteran families and children
transitioning to civilian life.
During this PMI, participants will be provided with information and
resources to learn about the specific cultural and contextual issues
that serve as the framework for delivery of evidence based practice
delivery for military and veteran families and children. Participants
will learn about current and updated prevalence levels of behavioral
health issues negatively impacting military and veteran families,
including PTSD, TBI, suicide, and other risk behaviors. Next, three
program developers will present overviews of major interventions adapted
or developed for military and veteran families and children including
TF-CBT, PCIT & Strong Families Strong Forces. Speakers will identify
the major military characteristics, risk factors, and organizational
issues (military and community partnerships) that have informed
development and adaptation of their evidence based practices (EBP) and
interventions for military families. Each presenter will describe their
EBP from the framework of addressing and overcoming issues and problems
commonly faced by military and veteran families through education,
prevention and delivery of interventions. Each program developer will
illustrate how the intervention objectives of each EBP have been adapted
to address particular issues related to deployment and combat stress,
transition issues, parental psychological and physical injury, as well
as child maltreatment. Strategies that highlight training at-risk
military families to utilize resilient skills and approaches will be
highlighted through the work of Strong Families Strong Forces. Programs
that emphasize improvement in parenting skills (PCIT) will be presented.
The program will include a presentation and discussion about the adapted
TF-CBT program for military families where the child has experienced a
traumatic stressor. Outcome data with military populations will be
presented to support further implementation of these interventions for
military and veteran families at risk for the negative impact of
military experiences.

PMI
12

STAIR Narrative Therapy: Flexible Applications

Spanish Track: This will be presented in English
with simultaneous translation to Spanish

Individuals exposed to sustained or multiple forms of trauma often
experience not only PTSD symptoms but also disturbances in
self-regulation functions particularly in emotion management and
relational capacities. These difficulties contribute significantly to
overall impairment and yet very few therapies routinely address them as
part of the recovery plan. Skills Training in Affective and
Interpersonal Regulation (STAIR) Narrative Therapy is an evidence-based
therapy that has successfully integrated skills training with narrative
work to address both the specific disturbances related to trauma (e.g.,
re-experiencing symptoms) as well as a range of transdiagnostic
affective and interpersonal problems. This workshop will review the
flexible use of and evidence for the treatment as adapted for group
modality and as formulated for the individual client to create a
"patient centered" program. Case examples and strategies for effective
implementation will be provided, with a special emphasis on male and
female veterans and women who have experienced military sexual trauma
(MST). Examples of implementation of the program using telemental health
(videoconferencing) will also be inlcuded.

Resick, Patricia, PhD1; Dondanville,
Katherine, PsyD21Duke
University Medical Center, Durham, North Carolina, United States2University of Texas Health Science Center at San Antonio,
San Antonio, Texas, United States

This half day institute is designed for practitioners trained in
Cognitive Processing Therapy (CPT/CPT-C) for posttraumatic stress
disorder (PTSD). The institute aims to enhance practitioners’
skills in adapting the protocol to various patient presentations and
populations. The institute will focus on Common Pitfalls that
practitioners come across when implementing CPT or CPT-C (without trauma
account) either individually or in a group context. Institute
participants will have an opportunity to guide the material based on
their personal interests and clinical consultation needs. Institute
participants are encouraged to present their own difficult PTSD cases
for consultation.

Though there will be some didactic materials presented, most of this
session will be “hands-on.” The Institute leaders will model
techniques, integrate up-to-date research, and share personal case
experiences. Brief video clips will be shown to demonstrate ways to
address common pitfalls. Most importantly, institute participants will
be asked to take part in partially scripted and unscripted role plays
where they will practice and evaluate their use of the skills.

The institute will address when to start the protocol with your patients
and address concerns about implementing the protocol with common
comorbidities. Once practitioners are using the protocol effectively,
confronting avoidance and enhancing patient engagement is an important
skill. How to flex the protocol and varying the length of treatment will
be explored with regard to decision making when to stop early or add
sessions. When to use emergency sessions or stop the protocol will also
be discussed. The institute will also focus on sharpening Socratic
Questioning skills and working with patients who stay stuck. How to
identify and challenge Just World Stuck Points will be addressed. This
is an Intermediate-Advanced level institute. Participants are expected
to have previous training and experience implementing CPT.